Foothill Cities - January-February 2022

By Kathy SanMartino, PT, BS, NCS, SCS, ATP/SMS, CLT-LAN Casa Colina Wheelchair & Seating Program Purchasing medical equipment should be done with professional guidance. Oftentimes, it can be a complicated and frustrating process! To determine whether an item is covered by your insurance, you can contact your insurance or vendor directly. When choosing a vendor, it is important to choose one who is a preferred provider for your insurance company. This will ensure the lowest possible co-pay for you. If coverage for an item is denied, it is important to see the reason for the denial in writing. Sometimes, it is simply a technicality— e.g. the dates on a form—that is the cause of the denial. Other times, it is an incomplete justification for the equipment. Wheelchairs are perhaps the most challenging “Durable Medical Equipment” for which to submit. Most insurance companies will follow guidelines similar to Medicare. If a power wheelchair, scooter, or custom manual wheelchair is requested, it must be required for mobility within the home. A physical therapy evaluation is required to evaluate the individual’s needs. The physical therapy evaluation must explain why a lesser piece of equipment is inadequate—i.e., if a power wheelchair is recommended, we must explain why a walker, manual wheelchair, or scooter is inappropriate. The physician must also evaluate the individual, and their documentation must reflect the findings of the physical therapist. When shopping for a wheelchair, you should look for a vendor with Assistive Technology Professional (ATP) certification. This certification indicates that the vendor is competent in evaluating an individual for assistive technology, such as wheelchairs. You should also look for a physical therapist who has ATP certification. This provides more assurance that the paperwork will be submitted correctly. If the paperwork is not compiled appropriately or is incomplete in any way, a denial may occur, or the whole process may be greatly delayed with resubmissions. If the wrong equipment is ordered for you and you accept it, you must keep it for 5 years. Your insurance will not consider ordering a new wheelchair for you unless your equipment is at least 5 years old or you have had a significant change in condition. Taking an active part in the whole process can speed up delivery of your medical equipment. This could include following the paper trail to ensure the physical therapist, physician, and vendor are completing and submitting the paperwork in a timely manner. If you would like to learn more tips for purchasing durable medical equipment, please call Casa Colina’s Outpatient Services at 909/596-7733, ext. 3500. Tips for purchasing Medical Equipment H E A L T H + B E A U T Y 32 | YourVilla Magazine Expires December 1, 2022 sampabjj.com 903 East Route 66, Glendora (626) 335-4971 Brazilian Jiu-Jitsu 4 for All Ages and Levels 4 Mix Martial Arts 4 Fitness Kickboxing In Person and Virtual Classes Builds Discipline and Confidence 2-WEEK FREE OFFER Limited time.